Provider Demographics
NPI:1356609739
Name:NTCO LLC
Entity type:Organization
Organization Name:NTCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEURET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-600-1137
Mailing Address - Street 1:PO BOX 790129
Mailing Address - Street 2:DEPT 30738
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0129
Mailing Address - Country:US
Mailing Address - Phone:918-904-8975
Mailing Address - Fax:918-517-3071
Practice Address - Street 1:2511 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1705
Practice Address - Country:US
Practice Address - Phone:918-904-8975
Practice Address - Fax:918-517-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6712100001Medicare NSC
OKOKA104397Medicare PIN